Tom Bodenheimer,of the Center for Excellence in Primary Care at UCSF Dep’t of Family and Community Medicine talks about addressing the primary care shortage at the 2014 Weitzman Symposium
This presentation explains the concept of the patient-centered medical home (PCMH), its function and its intended effects. A brief overview of the history of PCMH is also provided, as well as a discussion of its operational characteristics, its principles and outcomes, and what is expected in the future for the PCMH model.
Digital engagement of discharged ED patients through asynchronous surveys is important for several reasons:
1) Contacting patients after discharge through digital means rather than phone calls improves patient safety and satisfaction while reducing costs. Automating the process allows clinicians to efficiently address patient wellbeing issues.
2) Surveys that check on patient status and experience provide opportunities to identify care gaps, prevent return visits, and improve care quality over time based on patient feedback.
3) Hospitals are increasingly focused on patient experience metrics that link to value-based reimbursement and consumer loyalty. Digital surveys can enhance hospitals' understanding of the patient perspective in a low-cost, consistent manner.
PFCC Methodology and Practice: Deliver Ideal Care Experiences and Outcomes…By...EngagingPatients
The document describes the Patient and Family Centered Care (PFCC) methodology used at UPMC, a large integrated health system. The six-step PFCC methodology involves: 1) defining the care experience, 2) forming a guiding council, 3) observing the current state through shadowing, 4) identifying touchpoints through a working group, 5) creating a shared vision for an ideal experience, and 6) implementing improvement projects. The methodology aims to improve outcomes and experiences by engaging patients and families in co-designing care and breaking down silos between care providers. Examples of successful PFCC projects that improved discharge processes and communication through bedside rounding are provided.
2018 TBC Learning Collaborative Session 1, May 09 2018CHC Connecticut
This document provides an introduction to a learning collaborative on implementing team-based care (TBC) at health centers. It outlines the agenda for the first session, including introductions from six participating health centers where they describe their team members and a recent improvement. The goals are to review the collaborative structure and resources on TBC models and assessment tools to help teams get started on action period assignments.
Over half of patients at a rehabilitation hospital reported wanting greater involvement in their care decisions. To address this, the hospital conducted patient and family shadowing where observers followed patients to experience care from their perspective. This identified themes like explanations during rounds and involvement in discharge plans. A post-intervention survey found a statistically significant improvement in patients feeling involved in care decisions and clinically relevant improvements in understanding doctor explanations and recommending the hospital. Engaging medical leaders and balancing data with reflection time led doctors to change practices without formal rules.
The document discusses expanding the role of registered nurses (RNs) in primary care settings. It describes how RNs can take on responsibilities like complex care management, active schedule management, using data to monitor patient outcomes, and conducting co-visits with providers to increase access to care. Co-visits allow RNs to address minor issues while providers briefly review cases. The approach has led to improved access and patient satisfaction at Community Health Center, Inc.
Weitzman 2013: PCORI: Transforming Health CareCHC Connecticut
This document summarizes a presentation given by Joe Selby on the Patient-Centered Outcomes Research Institute (PCORI). It discusses PCORI's mission to fund comparative clinical effectiveness research that is guided by patients and other stakeholders. Key points include: PCORI's focus on research questions of interest to patients and providers; its criteria for funding proposals, including patient-centeredness and engagement; and its plans to significantly increase funding for such research over time. Examples are given of funded pilot projects involving community health centers.
Advancing Team-Based Care: Complex Care Management in Primary CareCHC Connecticut
This webinar investigated the ways that team members can contribute to the care of patients with complex medical and/or social needs. The focus was on developing the expanded care team and ensuring ready communication between the core and expanded care teams. Models for effective care management were presented.
This webinar was presented May 5, 2016 3:00 p.m. Eastern Time
Patient & Family Advisory Councils: the Business Case for Starting a PFAC & P...EngagingPatients
This webinar was presented on March 12, 2015 by Barbara Lewis. It looks at the prevalence and roles that Patient & Family Advisory Councils (PFACs) are playing in U.S. hospitals today, and builds a business case for their implementation:
This resource summarizes the eight recommendations outlined in the Institute of Medicine's a new consensus study entitled, Improving Diagnosis in Health Care. The recommendations are aimed at making diagnoses more accurate, reliable, efficient, and safe. This work is a continuation of the IOM’s Quality Chasm series.
Creating a standard of care for patient and family engagementChristine Winters
Nationally-recognized governance expert Beth Daley Ullem addresses the state of patient engagement in heathcare and provides a vision for establishing a minimum standard of care for patient engagement programs.
As patients and families impacted by harm, we imagine progressive approaches in responding to patient safety incidents – focused on restoring health and repairing trust.
We can change how we respond to healthcare harm by shifting the focus away from what happened, towards who has been affected and in what way. This is your opportunity to hear about innovative approaches in Canada, New Zealand, and the United States that appreciate these human impacts.
This interactive webinar is hosted by Patients for Patient Safety Canada, the patient-led program of the Canadian Patient Safety Institute and the Canadian arm of the World Health Organization Patients for Patient Safety Global Network.
Clinical Workforce Development NCA Informational WebinarCHC Connecticut
Learn more about training and technical assistance offered through Community Health Center Inc.'s National Cooperative Agreement (NCA) on Clinical Workforce Development. Hear more about FREE Learning Collaboratives opportunities to enhance or implement a model of Team-Based Care at your Health Center, and how to implement a Post-Graduate Residency program for Nurse Practitioners and Post-Doc Clinical Psychologists.
2021-2022 NTTAP Webinar: Fundamentals of Comprehensive CareCHC Connecticut
Join us as we discuss the core concepts of team-based care and introduce elements of team-based care that builds upon these basics to support your teams in advancing their capability to provide satisfying and effective care to complex patient populations. .
We will be joined by Margaret Flinter, Senior Vice President/Clinical Director for Community Health Center, Inc., and both Thomas Bodenheimer, MD, Physician and Founding Director, and Rachel Willard Grace, Director, from the Center for Excellence in Primary Care.
The document discusses lessons from the United States on caring for patients with chronic illnesses. It outlines three key functions of primary care teams: panel management to ensure patients receive evidence-based care, health coaching to support behavior change and medication adherence, and complex care management for high-needs patients. High-functioning teams with roles like registry use, panel managers, and health coaches are shown to improve health outcomes and lower costs compared to usual individual physician care.
The document discusses lessons from the United States on caring for patients with chronic illnesses. It outlines three key functions of primary care teams: panel management to ensure patients receive evidence-based care, health coaching to support behavior change and medication adherence, and complex care management for high-needs patients. High-functioning teams with roles like registry use, panel managers, and health coaches are shown to improve health outcomes and lower costs compared to usual individual physician care.
The document discusses integrating palliative care in the emergency department. It begins with an outline of topics to be discussed, including how early identification of end-of-life state can reduce low-value emergency care, how to integrate discussions of goals of care and advance care planning with families of resuscitation patients, and how to optimize treatment planning to reduce inappropriate CPR attempts. It then summarizes a study which found that among patients who underwent emergency resuscitation, palliative care was associated with fewer life-sustaining treatments and less medical expenses and utilization compared to standard care. The document discusses recognizing when a patient is actively dying, common reasons palliative care patients present to the emergency department, and palliative care skills relevant
For more information contact: Slideshare@marcusevans.com
Presentation delivered by Donna Medina, Regional Director,OSF Hospice and Homecare Foundation at the marcus evans Home Care Leadership Summit held on July 13 & 14 2015 in Palm Beach FL.
How are advances in social science being used to improve HCAHPS scores? Join Carol Packard, PhD, for key actions you can take to improve patient satisfaction scores, while improving clinical outcomes and reducing costs.
I didn't know this option of Palliative care existed prior to my mother's passing earlier this year of colorectal cancer. However, I do now know about it and want to share it with all of you
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
This document discusses the role of nurse practitioners in healthcare. It begins by defining advanced practice nurses, which includes nurse practitioners, clinical nurse specialists, certified nurse midwives, and certified nurse anesthetists. It then provides statistics on the number of each type of advanced practice nurse. The history and development of the nurse practitioner role is summarized, noting their increasing independence and scope of practice similar to primary care physicians. Outcomes research is highlighted showing nurse practitioners can effectively treat most patients and have equal or better health outcomes compared to physicians.
This document provides a summary of a presentation about palliative care efforts in Delaware. It discusses the difference between palliative care and hospice, current palliative care programs available in Delaware, and opportunities for expansion. Key points include:
- Palliative care aims to improve quality of life by relieving symptoms for patients with serious illnesses, while hospice focuses on the last 6 months of life after curative treatments stop.
- Delaware has several palliative care programs in hospitals, home care, and long-term care settings, but access could be expanded by having palliative specialists in all hospitals and outside of hospitals.
- Opportunities remain to improve palliative care in Delaware through increasing the number of board
Cheshire and Wirral Best Practice event - 8 NovemberInnovation Agency
The document outlines plans for developing integrated care communities across South Cheshire and Vale Royal. Key points include:
- The formation of 5 care community teams to provide coordinated, patient-centered care across the region.
- Initial priority projects include developing the care community teams, improving GP out-of-hours care, and musculoskeletal physiotherapy.
- Achievements so far include aligning staff to the 5 communities, implementing rapid response services, and beginning multidisciplinary team meetings.
- Future goals involve strengthening primary care partnerships, expanding social care support, and using data to better manage patient risk levels.
This document summarizes 5 research studies that will impact clinical practice for academic family physicians. It discusses studies on appropriate use of antithrombotic medication in atrial fibrillation patients, the association between neighborhood walkability and rates of overweight/obesity/diabetes, predictors of frequent primary care visits among older patients, differences in patient experience survey responses based on survey delivery method, and a randomized trial on oral/topical antibiotics for infected eczema in children. The document analyzes the research questions, methods, findings and implications of each study.
This document discusses issues relating to aging and frailty in general practice. It provides data from the BEACH study showing older patients have more consultations per year that are longer in length. It recommends general practices develop health and social summaries, care plans, and escalation plans for older patients to improve coordination of care. This includes documenting goals, responsibilities, review timelines, and preferences for urgent or end of life care situations. Screening tools like FRAIL can help identify patients at risk of frailty who may need additional support. Quality improvement efforts should focus on improving systems to better meet the needs of older patients.
Five priorities for care of the dying personMarie Curie
Dr Bill Noble, Medical Director of Marie Curie Cancer Care, speaks at the end of life sesion with Dr Adam Firth (RCGP Clinical Support Fellow for End of Life Care).
This session was chaired by Dr Peter Nightingale, Marie Curie and RCGP End of life lead at the RCGP Annual Conference, ACC Liverpool, 2-4 October, 2014.
For more information visit: mariecurie.org.uk/rcgp
How evidence affects clinical practice in egyptWafaa Benjamin
Evidence based medicine is the gold standard for clinical care.
It implies the integration of best research evidence with clinical expertise and patient values.
There is still a wide gap between availability of evidence and its incorporation into routine practice in our country.
Barriers to implementation could be personal, social, institutional, financial and legal barriers.
True practice of evidence based care can only occur where evidence based decisions coincide with patients’ beliefs and clinicians’ preferences.
Continuing medical education programs should be set with integrating evidence based medicine teaching and learning within clinical training.
The importance of presence of local national guidelines which need to take into account variation in expertise, resources and patient preferences across our geographical and cultural contexts .
Customisation of a guideline to meet the local needs of a target patient population is critical to successful implementation.
Risk profiling, multiple long term conditions & complex patients, integrated ...Dr Bruce Pollington
Dr Bruce Pollington web-ex presentation to LTC QIPP programme
Utilising risk profiling, and risk stratification to identify patients with multiple long term conditions requiring complex care through integrated care teams.
What does a palliative approach look like in residential careBCCPA
This document provides an overview of a palliative care pilot project in residential care facilities. The goals were to enhance end-of-life care for residents and their families, improve the care team experience, and reduce hospitalizations. The project team implemented educational sessions, palliative care rounds, and engaged physicians. Early results found decreased hospital admissions and increased confidence in conversations about palliative care. Evaluation included focus groups with staff, families and the project team to assess the impact and identify factors for successful implementation.
The Wessex Acute Frailty Audit found variability in how hospitals screen for and manage frailty. Screening for frailty sometimes occurred in emergency departments and acute medical units, but practices were inconsistent across sites. The audit aims to improve standards of care for frail patients in hospitals by identifying gaps and encouraging quality improvement. Further work is needed to drive consistency in frailty screening, management and care transitions.
This document discusses the hospitalist model and debunks myths about it. It summarizes research showing that hospitalists can reduce length of stay and costs without harming quality of care. While primary care physicians initially had concerns about loss of continuity and poor communication, studies show patient, family, and physician satisfaction are preserved or improved with hospitalists. For hospitals, hospitalists can increase efficiency and market share. The model has grown significantly since being introduced.
Similar to Can we solve the adult primary care shortage without more physicians? (20)
The COVID-19 pandemic has created several challenges for our country’s health care infrastructure, and the community health center workforce is no exception. Join us as we describe strategies to get patients back into dental care. Along with these strategies, participants will learn how to recognize challenges in dental practices, as well as how to engage the interdisciplinary care team through role redesign and integration to increase access to comprehensive care.
NTTAP Webinar Series - June 7, 2023: Integrating HIV Care into Training and E...CHC Connecticut
In order for health centers to provide compassionate and respectful HIV prevention, care, and treatment in comprehensive primary care settings, the clinical workforce must be knowledgeable, confident, and competent in their ability to do so.
We’ll explore the need to integrate HIV care into training and education for the clinical care team, as well as educational models to train the next generation. Using Community Health Center Inc.’s Center for Key Populations Fellowship for Nurse Practitioners (NPs) as a framework for best practices, experts will discuss how to implement specialty care for key populations in your training programs. Additionally, participants will gain awareness of the importance of training the clinical workforce on key population competencies in HIV programs (e.g. HCV, MOUD, LGBTQI+ health, homelessness, and harm reduction).
Utilizing the Readiness to Train Assessment Tool (RTAT™) To Assess Your Capac...CHC Connecticut
Improve educational training experiences at your health center by assessing your capacity and infrastructure to host health professions students.
Join the upcoming hands-on interactive activity session to learn how to utilize the Readiness to Train Assessment Tool (RTAT™). This tool was developed by HRSA-funded National Training and Technical Assistance Partners (NTTAP) at Community Health Center, Inc. (CHC) to understand organizational readiness to host health professions student training programs.
NTTAP Webinar Series - May 18, 2023: The Changing Landscape of Behavioral Hea...CHC Connecticut
The COVID-19 pandemic has resulted in significant shifts in the mode of care from face-to-face to virtual interactions. Join us as we discuss the challenges currently facing behavioral health care and at least one strategy for each. Along with these strategies, panelists will go over what integrated behavioral health care was and is before and following COVID-19, as well as what actions should be taken going forward to increase access to comprehensive care.
Panelists:
• Dr. Tim Kearney, PhD, Chief Behavioral Health Officer, Community Health Center, Inc.
• Melinda Gladden, LCSW, PMHC, Behavioral Health Clinician, Community Health Center, Inc.
• Jodi Anderson, LMFT, Virtual Telehealth Group Coordinator, Community Health Center, Inc.
Newborn screening involves testing newborns for treatable genetic and metabolic disorders through methods like dried bloodspot testing, hearing screening, and pulse oximetry. The goals are to identify at-risk newborns early before symptoms present, when treatment is most effective. Abnormal screening results require follow up diagnostic testing, education of families, and treatment if a condition is confirmed. Future directions may include expanded screening panels and genomic newborn screening, though these raise additional complex issues to consider.
Health Professions Student Training Webinar: Assessing Organizational CapacityCHC Connecticut
This document provides information about a webinar on assessing organizational capacity for health professions student training. It includes details about continuing education credits, speakers, objectives, and an overview of key aspects of assessing capacity. These include identifying willing and available faculty members, maintaining a spreadsheet of available preceptors, conducting a secondary review of space, training, and onboarding needs, and negotiating placements with academic affiliations. It also discusses best practices for clinical observation and feedback forms, and introduces some preceptor panelists. Finally, it provides an overview of the Readiness to Train Assessment Tool (RTAT) and how it can be used to understand an organization's capacity based on survey results.
Training the Next Generation: Investing in Workforce TrainingCHC Connecticut
This document provides information about an upcoming webinar on workforce training. The webinar will discuss why health centers should invest in health professions education and training programs, how to assess organizational readiness to implement such programs, and best practices for developing replicable training models. Attendees will learn how workforce development planning makes business sense by reducing costs from employee turnover and increasing access to care. A tool called the Readiness to Train Assessment can help organizations evaluate their capacity and motivation to engage in training programs. Successful training requires identifying qualified preceptors and building a culture of learning in the organization.
NTTAP Webinar Series - April 13, 2023: Quality Improvement Strategies in a Te...CHC Connecticut
Join us for a webinar on quality improvement in team-based care!
Building a quality improvement (QI) infrastructure within team-based care is an organizational strategy that will establish a culture of continuous improvement across departments and improve quality in all domains of performance.
Participants will learn about:
• QI infrastructure
• Facilitating QI committees
• Coach training within health centers
Faculty will also provide an example of how trained coaches use QI tools to test and implement changes within an organization.
Addressing Genetics Workforce Shortage - April 11, 2023CHC Connecticut
The document discusses the shortage of geneticists and genetic counselors in the United States. It notes that there are currently only around 1,240 medical geneticists and 4,700 genetic counselors serving the population, below the recommended levels. Many states have fewer than the recommended number of geneticists per population. The document explores ways primary care physicians can help address gaps, such as playing a more active role in selected genetic situations like cancer risk assessment. It also identifies growing the educational opportunities in genetics as important for increasing the workforce.
Implementation of Timely and Effective Transitional Care Management ProcessesCHC Connecticut
Join us to discuss best practices for integrating daily follow-ups for patients recently hospitalized for health emergencies. Effectively following up with patients is a critical responsibility for integrated care teams.
Experts will share how their teams respond to patients to identify care gaps and support the transition of care. Workflow descriptions will provide participants with the tools to support their work to adapt specific steps into their model of team-based care.
Panelists:
• Mary Blankson, DNP, APRN, FNP-C, FAAN, Chief Nursing Officer, Community Health Center, Inc.
• Veena Channamsetty, MD, FAAFP, Chief Medical Officer, Community Health Center, Inc.
• Bibian Ladino-Davis, Behavioral Health Coordinator, Weitzman Institute
Direct to Consumer Test and Ancestry Testing - March 14, 2023CHC Connecticut
Direct to Consumer Genetic and Ancestry Testing
This document discusses direct-to-consumer (DTC) genetic and ancestry testing. It defines DTC testing as testing that can be ordered by consumers without a health care provider. The document outlines the types of information provided by DTC tests, including ancestry, traits, disease risks, and results for some Mendelian conditions. However, it notes limitations like low predictive value without family history and risks of false positives. It provides examples of patients impacted by DTC testing results and emphasizes the need for confirmation of pathogenic variants by clinical genetics. The document also discusses privacy and legal issues related to DTC testing.
Implement Behavioral Health Training Programs to Address a Crucial National S...CHC Connecticut
Health centers are uniquely positioned to address the unprecedented need for behavioral health services but are challenged by the workforce shortage. Participants will gain the knowledge needed to begin conceptualization of a training pathway.
Join us to discuss the considerations of sponsoring an in-house training program across all educational levels, including the benefits, program structure, design, curriculum, supervisors' role, and required resources.
Experts will provide participants with examples from practicum and postdoctoral level training programs to help them gain confidence in developing a behavioral health training pathway.
Genetic Connections to Breast Cancer - February 14, 2023CHC Connecticut
This document discusses genetic connections to breast cancer. It begins by outlining the learning objectives, which are to understand the importance of collaboration between genetics and non-genetics experts for hereditary breast cancer patients, emphasize obtaining accurate family histories, and discuss benefits and limitations of next generation sequencing panel tests. It then discusses genetic counselors' role in oncology, hereditary cancer risks and patterns, BRCA genes, obtaining family histories, genetic testing options like multi-gene panels, interpreting results, cancer screening recommendations, and prophylactic surgery options. Resources and established risk models are also referenced.
Connective Tissue Disorders Slides - January 17, 2023CHC Connecticut
This document discusses several genetic connective tissue disorders including Ehlers Danlos syndromes, Marfan syndrome, Loeys-Dietz syndrome, Stickler syndrome, Shprintzen Goldberg syndrome, Cutis Laxa, and Osteogenesis Imperfecta. It highlights the importance of identifying these disorders to allow for timely detection of serious complications and management by multiple medical specialists. Connective tissues are the most abundant tissues in the body and connect, support, bind or separate other tissues. Identification of a connective tissue disorder through genetic diagnosis guides appropriate care.
Implementation of Facial Recognition Software for Clinical Genetics Practice...CHC Connecticut
This document discusses the potential uses of facial recognition software in clinical genetics practice and education. It provides 3 examples of how facial recognition software could help in rare disease identification and interpreting genetic testing results. The document also outlines learning objectives about identifying medical uses of facial recognition, using facial grids to match patterns to syndromes, and the importance of diverse training data.
HIV Prevention: Combating PrEP Implementation ChallengesCHC Connecticut
Expert faculty present case-based scenarios illustrating common challenges to integrating HIV PrEP in primary care. As part of improving clinical workforce development, this session will delve into a variety of specific PrEP implementation challenges. Participants will leave with strategies to overcome these obstacles to establish or strengthen their PrEP program.
Panelists:
• Marwan Haddad, MD, MPH, AAHIVS, Medical Director, Center for Key Populations, Community Health Center, Inc.,
• Jeannie McIntosh, APRN, FNP-C, AAHIVS, Family Nurse Practitioner, Center for Key Populations, Community Health Center, Inc.
NTTAP Webinar Series - December 7, 2022: Advancing Team-Based Care: Enhancing...CHC Connecticut
Join us as expert faculty outline the differences between case management, care coordination and complex care management to frame up a discussion on strategies to leverage effective models for both in-person and remote services.
Expert faculty will discuss the role of the medical assistant and the nurse in care management, as well as how standing orders and delegated orders support this work. This session will discuss how telehealth and remote patient monitoring enhancements can support complex care management for patients with chronic conditions.
Participants will leave this session with the knowledge and tools to begin or enhance implementation of chronic care management by enhancing the role of the medical assistant, nurse and the technology that supports the clinical care.
Panelists:
• Mary Blankson, DNP, APRN, FNP-C, Chief Nursing Officer, Community Health Center, Inc.
• Tierney Giannotti, MPA, Senior Program Manager, Population Health, Community Health Center Inc.
Genetics Cases and Resources Webinar Slides - November 8, 2022CHC Connecticut
The document discusses various metabolic diseases, including those that cause muscle symptoms like long chain hydroxyacyl CoA dehydrogenase (LCHAD) deficiency and Pompe disease. It provides information on fatty acid oxidation defects, describing how the body metabolizes fatty acids and the consequences of defects in breaking down different chain length fatty acids. Symptoms of long chain fatty acid oxidation defects are discussed, including fasting intolerance, encephalopathy, liver dysfunction, and muscle involvement. The diagnosis and treatment of these conditions is also summarized.
NTTAP Webinar: Postgraduate NP/PA Residency: Discussing your Key Program Staf...CHC Connecticut
This document discusses a webinar presented by Community Health Center, Inc. on their postgraduate nurse practitioner and physician assistant residency and fellowship programs. It provides an agenda for the webinar which will discuss the key program staff and their responsibilities, including the program director, clinical director, preceptors, mentors and other faculty. The webinar objectives are to identify drivers for implementing such programs, describe the implementation process, discuss program structure and highlight the roles of program staff.
Training the Next Generation within Primary CareCHC Connecticut
This document summarizes a presentation about training the next generation within primary care. It discusses Community Health Center Inc.'s various workforce development programs, including clinical and non-clinical fellowships and student programs. Specifically, it focuses on administrative fellowships, outlining their purpose and key factors to consider when establishing one, such as the fellow's access and experiences. It also describes other opportunities at the Weitzman Institute for training students, such as research programs with Wesleyan University and health policy fellowships. The presentation emphasizes that community health centers are important training grounds and considers how to structure diverse programs to support succession planning.
Hemodialysis: Chapter 8, Complications During Hemodialysis, Part 2 - Dr.GawadNephroTube - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/FHV_jNJUt3Y
- Video recording of this lecture in Arabic language: https://youtu.be/D5kYfTMFA8E
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Pharmacotherapy of Asthma and Chronic Obstructive Pulmonary Disease (COPD)HRITHIK DEY
This PowerPoint presentation provides an in-depth overview of the pharmacotherapy approaches for managing asthma and Chronic Obstructive Pulmonary Disease (COPD). It covers the pathophysiology of these respiratory conditions, the various classes of medications used, their mechanisms of action, indications, side effects, and the latest treatment guidelines. Designed for students, healthcare professionals, and anyone interested in respiratory pharmacology, this presentation offers a comprehensive understanding of current therapeutic strategies and advancements in the field.
A comparative study on uroculturome antimicrobial susceptibility in apparentl...Bhoj Raj Singh
The uroculturome indicates the profile of culturable microbes inhabiting the urinary tract, and it is often required to do a urine culture to find an effective antimicrobial to treat UTIs. This study targeted to understand the profile of culturable pathogens in the urine of apparently healthy (128) and humans with clinical UTIs (161). In urine samples from UTI cases, microbial counts were 1.2×104 ± 6.02×103 colony-forming units (cfu)/ mL, while in urine samples from apparently healthy humans, the average count was 3.33± 1.34×103 cfu/ mL. In eight samples (six from UTI cases and two from apparently healthy people) of urine, Candida (C. albicans 3, C. catenulata 1, C. krusei 1, C. tropicalis 1, C. parapsiplosis 1, C. gulliermondii 1) and Rhizopus species (1) were detected. Candida krusei was detected only in a single urine sample from a healthy person and C. albicans was detected both in urine of healthy and clinical UTI cases. Fungal strains were always detected with one or more types of bacteria. Gram-positive bacteria were more commonly (OR, 1.98; CI99, 1.01-3.87) detected in urine samples of apparently healthy humans, and Gram -ve bacteria (OR, 2.74; CI99, 1.44-5.23) in urines of UTI cases. From urine samples of 161 UTI cases, a total of 90 different types of microbes were detected and, 73 samples had only a single type of bacteria. In contrast, 49, 29, 3, 4, 1, and 2 samples had 2, 3, 4, 5, 6 and 7 types of bacteria, respectively. The most common bacteria detected in urine of UTI cases was Escherichia coli detected in 52 samples, in 20 cases as the single type of bacteria, other 34 types of bacteria were detected in pure form in 53 cases. From 128 urine samples of apparently healthy people, 88 types of microbes were detected either singly or in association with others, from 64 urine samples only a single type of bacteria was detected while 34, 13, 3, 11, 2 and 1 samples yielded 2, 3, 4, 5, 6 and seven types of microbes, respectively. In the urine of apparently healthy humans too, E. coli was the most common bacteria, detected in pure culture from 10 samples followed by Staphylococcus haemolyticus (9), S. intermedius (5), and S. aureus (5), and similar types of bacteria also dominated in cases of mixed occurrence, E. coli was detected in 26, S. aureus in 22 and S. haemolyticus in 19 urine samples, respectively. Gram +ve bacteria isolated from urine samples' irrespective of health status were more often (p, <0.01) resistant than Gram -ve bacteria to ajowan oil, holy basil oil, cinnamaldehyde, and cinnamon oil, but more susceptible to sandalwood oil (p, <0.01). However, for antibiotics, Gram +ve were more often susceptible than Gram -ve bacteria to cephalosporins, doxycycline, and nitrofurantoin. The study concludes that to understand the role of good and bad bacteria in the urinary tract microbiome more targeted studies are needed to discern the isolates at the pathotype level.
Exploring Alternatives- Why Laparoscopy Isn't Always Best for Hydrosalpinx.pptxFFragrant
Not all women with hydrosalpinx should choose laparoscopy. Natural medicine Fuyan Pill can also be a nice option for patients, especially when they have fertility needs.
Causes Of Tooth Loss
PERIODONTAL PROBLEMS ( PERIODONTITIS, GINIGIVITIS)
Systemic Causes Of Tooth Loss
1. Diabetes Mellitus
2. Female Sexual Hormones Condition
3. Hyperpituitarism
4. Hyperthyroidism
5. Primary Hyperparathyroidism
6. Osteoporosis
7. Hypophosphatasia
8. Hypophosphatemia
Causes Of Tooth Loss
CARIES/ TOOTH DECAY
Causes Of Tooth Loss
CAUSES OF TOOTH LOSS
Consequence of tooth loss
Anatomic
Loss of ridge volume both height and width
Bone loss :
mandible > maxilla
Posteriorly > anteriorly
Anatomic consequences
Broader mandibular arch with constricting maxilary arch
Attached gingiva is replaced with less keratinised oral mucosa which is more readily traumatized.
Anatomic consequences
Tipping of the adjacent teeth
Supraeruption of the teeth
Traumatic occlusion
Premature occlusal contact
Anatomic Consequences
Anatomic Consequences
Physiologic consequences
Physiologic Consequences
Decreased lip support
Decreased lower facial height
Physiologic Consequences
Physiologic consequences
Education of Patient
Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation
Support for Distal Extension Denture Bases
Establishment and Verification of Occlusal Relations and Tooth Arrangements
Initial Placement Procedures
Periodic Recall
Education of Patient
Informing a patient about a health matter to
secure informed consent.
Patient education should begin at the initial
contact with the patient and should continue throughout treatment.
The dentist and the patient share responsibility for the ultimate success of a removable partial denture.
This educational procedure is especially important when the treatment plan and prognosis are discussed with the patient.
Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation
Begin with thorough medical and dental histories.
The complete oral examination must include both clinical and radiographic interpretation of:
caries
the condition of existing restorations
periodontal conditions
responses of teeth (especially abutment teeth) and residual ridges to previous stress
The vitality of remaining teeth
Continued…..
Occlusal plan evaluation
Arch form
Evaluation of Occlusal relationship through mounting the diagnostic cast
The dental cast surveyor is an absolute necessity in which patients are being treated with removable partial dentures.
Mouth preparations, in the appropriate sequence, should be oriented toward the goal of
providing adequate support, stability,
retention, and
a harmonious occlusion for the partial denture.
Support for Distal Extension Denture Bases
A base made to fit the anatomic ridge form does not provide adequate support under occlusal loading.
The base may be made to fit the form of the ridge when under function.
Support for Distal Extension Denture Bases
This provides support
Ontotext’s Clinical Trials Eligibility Design Assistant helps with one of the most challenging tasks in study design: selecting the proper patient population.
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Chair, Benjamin M. Greenberg, MD, MHS, discusses neuromyelitis optica spectrum disorder in this CME activity titled “Mastering Diagnosis and Navigating the Sea of Targeted Treatments in NMOSD: Practical Guidance on Optimizing Patient Care.” For the full presentation, downloadable Practice Aids, and complete CME information, and to apply for credit, please visit us at https://bit.ly/4av12w4. CME credit will be available until June 27, 2025.
Coronary Circulation and Ischemic Heart Disease_AntiCopy.pdfMedicoseAcademics
In this lecture, we delve into the intricate anatomy and physiology of the coronary blood supply, a crucial aspect of cardiac function. We begin by examining the physiological anatomy of the coronary arteries, which lie on the heart's surface and penetrate the cardiac muscle mass to supply essential nutrients. Notably, only the innermost layer of the endocardial surface receives direct nourishment from the blood within the cardiac chambers.
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Case presentation of a 14-year-old female presenting as unilateral breast enlargement and found to have a giant breast lipoma. The tumour was successfully excised with the result that the presumed unilateral breast enlargement reverting back to normal. A review of management including a photo of the removed Giant Lipoma is presented.
JMML is a rare cancer of blood that affects young children. There is a sustained abnormal and excessive production of myeloid progenitors and monocytes.
Can we solve the adult primary care shortage without more physicians?
1. Can we solve the adult primary care shortageCan we solve the adult primary care shortage
without more physicians?without more physicians?
Tom BodenheimerTom Bodenheimer
Center for Excellence in Primary CareCenter for Excellence in Primary Care
UCSF Dep’t of Family and Community MedicineUCSF Dep’t of Family and Community Medicine
Weitzman Symposium 2014Weitzman Symposium 2014
2. Colwill et al., Health Affairs, 2008:w232Colwill et al., Health Affairs, 2008:w232
Petterson et al, Ann Fam Med 2012;10:503Petterson et al, Ann Fam Med 2012;10:503
0
5
10
15
20
25
30
35
40
45
50
2000 2005 2010 2015 2020
Percent change relative to 2001
Adult care: projected generalist physicianAdult care: projected generalist physician
supply vs. demandsupply vs. demand
Demand:adult popDemand:adult pop’n’n
growth/aginggrowth/aging
Supply: familySupply: family
med, generalmed, general
internal medinternal med
Shortage of 40,000 by 2020
Shortage of 52,000 by 2025
3. NP/PAs to the rescue?NP/PAs to the rescue?
• New graduates each yearNew graduates each year
– Nurse practitioners:Nurse practitioners: 80008000
– Physician assistants:Physician assistants: 45004500
• % going into primary care% going into primary care
– NPs:NPs: 65%65%
– PAs:PAs: 32%32%
• Adding new GIM, FamMed, NPs, and PAsAdding new GIM, FamMed, NPs, and PAs
entering primary care each year, the primary careentering primary care each year, the primary care
clinician to population ratio will fall byclinician to population ratio will fall by 9%9% fromfrom
2005 to 2020.2005 to 2020.
Colwill et al, Health Affairs Web Exclusive, April 29, 2008; Bodenheimer et al,Colwill et al, Health Affairs Web Exclusive, April 29, 2008; Bodenheimer et al,
Health Affairs 2009;28:64.Health Affairs 2009;28:64.
4. Panel sizes too large to managePanel sizes too large to manage
• Average primary care panel in US isAverage primary care panel in US is 23002300
• PCP with panel of 2500 average patients willPCP with panel of 2500 average patients will
spendspend 7.4 hours per day7.4 hours per day doing recommendeddoing recommended
preventive carepreventive care [Yarnall et al. Am J Public Health 2003;93:635][Yarnall et al. Am J Public Health 2003;93:635]
• PCP with panel of 2500 average patients willPCP with panel of 2500 average patients will
spendspend 10.6 hours per day10.6 hours per day doing recommendeddoing recommended
chronic carechronic care [Ostbye et al. Annals of Fam Med 2005;3:209][Ostbye et al. Annals of Fam Med 2005;3:209]
5. Results of large panelsResults of large panels
• Poor access for patientsPoor access for patients
• Inconsistent qualityInconsistent quality
• Lack of time to build relationships with patientsLack of time to build relationships with patients
• Clinician burnoutClinician burnout
– Survey of 422 general internists, family physiciansSurvey of 422 general internists, family physicians
• 27%: definitely burning out27%: definitely burning out
• 30%: likely to leave the practice within 2 years30%: likely to leave the practice within 2 years
– Physician burnout is associated with poor patientPhysician burnout is associated with poor patient
experience and reduced patient adherence toexperience and reduced patient adherence to
treatment planstreatment plans
Linzer et al. Annals of Internal Medicine 2009;151:28-36; Dyrbye, JAMA 2011;305:2009; Murray etDyrbye, JAMA 2011;305:2009; Murray et
al, JGIM 2001:16,452; Landon et al, Med Care 2006;44:234.al, JGIM 2001:16,452; Landon et al, Med Care 2006;44:234.
6. The dilemmaThe dilemma
• Panel size too large for average PCP to managePanel size too large for average PCP to manage
• We can’t reduce panel size due to worseningWe can’t reduce panel size due to worsening
shortage of adult primary care cliniciansshortage of adult primary care clinicians
• Shortage = larger panels, poorer access forShortage = larger panels, poorer access for
patients, poorer quality, more PCP burnout, higherpatients, poorer quality, more PCP burnout, higher
health care costshealth care costs
• More PCP burnout means fewer medical studentsMore PCP burnout means fewer medical students
will be attracted to primary carewill be attracted to primary care
Unless we think differentlyUnless we think differently
7. Re-defining the adult primary care shortageRe-defining the adult primary care shortage
• Most people define it as a physician shortageMost people define it as a physician shortage
• Or a clinician shortage (MDs, NPs, PAs)Or a clinician shortage (MDs, NPs, PAs)
• These formulations are aThese formulations are a bridge to nowherebridge to nowhere
• If clinician shortage is the problem, then the only solutionIf clinician shortage is the problem, then the only solution
is more cliniciansis more clinicians
• More clinicians would help, but there willMore clinicians would help, but there will nevernever be enoughbe enough
• We must re-define the shortage as a demand-capacity gapWe must re-define the shortage as a demand-capacity gap
• We address the gap by increasing capacity and/or reducingWe address the gap by increasing capacity and/or reducing
demanddemand
• We can do this without more cliniciansWe can do this without more clinicians
8. 0
5
10
15
20
25
30
35
40
45
50
2000 2005 2010 2015 2020
Percent change relative to 2001
Adult primary care: capacity vs. demandAdult primary care: capacity vs. demand
Demand for careDemand for care
==
Capacity toCapacity to
provide careprovide care
Thinking differentlyThinking differently
It’s not only about doctorsIt’s not only about doctors
Share the careShare the care
9. Clinica Family
Health Services
Group Health Olympia
Multnomah County
Health Dept
South Central
Foundation
Univ of Utah-
Redstone
Newport News
Family Practice
Cleveland Clinic-
Stonebridge
Quincy, Office of
the Future
West Los Angeles-
VA
La Clinica de
la Raza
Clinic Ole
Sebastopol
Community
Health
Martin’s Point-
Evergreen Woods
Harvard Vanguard
Medford
Brigham and
Women’s and MGH
Ambulatory
Practice of the
Future
North Shore
Physicians Group
Medical Associates
Clinic
Mercy Clinics
ThedaCare
Fairview Rosemont
Clinic
Mayo Red Center
Allina
23 High-Performing Practices23 High-Performing Practices
10. 10 Building Blocks of
High-Performing
Primary Care
Annals of Family Medicine
2014;12:166-71
Team-based careTeam-based care
11. Closing the demand-capacity gap: share the careClosing the demand-capacity gap: share the care
• CliniciansClinicians
• Non-clinician team membersNon-clinician team members
– Non-professionalNon-professional
• MAs as panel managersMAs as panel managers
• MAs as health coachesMAs as health coaches
• MAs as scribesMAs as scribes
– ProfessionalProfessional
• RNsRNs
• PharmacistsPharmacists
• BehavioristsBehaviorists
• PatientsPatients
– Peer health coachesPeer health coaches
– Self careSelf care
• TechnologyTechnology
Bodenheimer and Smith, Health Affairs 2013;32:1881-6Bodenheimer and Smith, Health Affairs 2013;32:1881-6
12. Share the care: who does it now?Share the care: who does it now?
Tasks PCP RN LPN Medical
assistant
Pharmacist
Orders mammograms for
healthy women between 50
and 75 years old
Refills high blood pressure
medications for patients
with well-controlled
hypertension
Performs diabetes foot
exams
Reviews lab tests to
separate normals from
abnormals
Cares for patients with
uncomplicated urinary
tract infections
Finds patients who are
overdue for LDL and
orders lipid panel
Prescribes statins for
patients with elevated LDL
Does medication
reconciliation
Screens patients for
depression using PHQ 2
and PHQ 9
Follows up by phone with
patients treated for
depression
Totals
13. Share the care: preserve the relationshipShare the care: preserve the relationship
• Share the Care means that the personal clinicianShare the Care means that the personal clinician
does not provide all the caredoes not provide all the care
• Patients should not be asked to transfer trust from a
clinician to a large team
• Historically patients trust a small team (teamlet)
• The relationship changes from patient-clinician toThe relationship changes from patient-clinician to
patient-teamletpatient-teamlet
• Members of the larger team are involved if neededMembers of the larger team are involved if needed
• Blue Shield of California Foundation survey: patientsBlue Shield of California Foundation survey: patients
are willing to receive care from a team even if itare willing to receive care from a team even if it
means seeing their physician less (June 2012)means seeing their physician less (June 2012)
14. Team-based care: stable teamlets
Patient
panel
1 team, 3 teamlets
Clinician + MA
teamlet
Patient
panel
Clinician + MA
teamlet
Patient
panel
Clinician + MA
teamlet
RN, behavioral health professional, social worker, pharmacist,
complex care manager
17. Sharing the care with non-clinicianSharing the care with non-clinician
team membersteam members
• Panel managementPanel management
– MAs use preventive and chronic disease registries,MAs use preventive and chronic disease registries,
and EMR health maintenance screens, to identifyand EMR health maintenance screens, to identify
patients with care caps and close the care gapspatients with care caps and close the care gaps
– Standing ordersStanding orders are needed to empower the MAsare needed to empower the MAs
– Best done within the teamletBest done within the teamlet
– Quality of preventive services improvesQuality of preventive services improves [Chen and[Chen and
Bodenheimer, Arch Intern Med 2011;171:1558]Bodenheimer, Arch Intern Med 2011;171:1558]
18. Clinician confidence that medical assistantsClinician confidence that medical assistants
will do a good job on panel managementwill do a good job on panel management
2012 Survey of 231 PCPs2012 Survey of 231 PCPs
Source: System Transformation Evaluation Survey (STEP). 2012. Available at http://familymedicine.medschool.ucsf.edu/cepc/
19. Preventive services: new wayPreventive services: new way
• MA (panel manager) checks registry every monthMA (panel manager) checks registry every month
• If due for mammo, MA sends mammo order to patientIf due for mammo, MA sends mammo order to patient
• Result comes to MA, if normal, MA notifies patientResult comes to MA, if normal, MA notifies patient
• If abnormal MA notifies clinician and app’t madeIf abnormal MA notifies clinician and app’t made
• For most patients, clinician is not involvedFor most patients, clinician is not involved
• For women 40-50 who want or need mammogram,For women 40-50 who want or need mammogram,
clinician is involved for discussionclinician is involved for discussion
• Similar for colon cancer screeningSimilar for colon cancer screening
• Requires standing ordersRequires standing orders
20. Sharing the care with non-clinicianSharing the care with non-clinician
team membersteam members
• Health coachingHealth coaching
– MAs trained as health coaches can assist patients with chronicMAs trained as health coaches can assist patients with chronic
conditions to become informed active participants in their careconditions to become informed active participants in their care
[Margolius et al, Annals of Family Medicine 2012;10:199; Ivey et al, Diab Spectrum 2012;25:93;[Margolius et al, Annals of Family Medicine 2012;10:199; Ivey et al, Diab Spectrum 2012;25:93;
Gensichen et al, Ann Intern Med 2009;151:369; Willard et al, in press]Gensichen et al, Ann Intern Med 2009;151:369; Willard et al, in press]
• Example: diabetesExample: diabetes
– Closing the loop to check for understanding (50% don’tClosing the loop to check for understanding (50% don’t
remember what happened in the clinician visit)remember what happened in the clinician visit)
– Know your ABC numbers (A1c, BP, Cholesterol)Know your ABC numbers (A1c, BP, Cholesterol)
– Know your ABC goalsKnow your ABC goals
– Know how to get from your number to your goalKnow how to get from your number to your goal
– Behavior change goal-setting and action plansBehavior change goal-setting and action plans
– Know your medications, and med adherence counselingKnow your medications, and med adherence counseling
• Difficult to do on teamlet unless 2 MAs per clinicianDifficult to do on teamlet unless 2 MAs per clinician
21. Health coaching in the teamlet modelHealth coaching in the teamlet model
22. Chronic care: hypertension: new wayChronic care: hypertension: new way
• MA checks registry every monthMA checks registry every month
• Patients with abnormal BP contacted for pharmacist, RN,Patients with abnormal BP contacted for pharmacist, RN,
or health coach visitor health coach visit
• Health coach: education, med adherence, lifestyle changeHealth coach: education, med adherence, lifestyle change
• If BP elevated and patient med adherent, RN/pharmacistIf BP elevated and patient med adherent, RN/pharmacist
intensifies meds by standing ordersintensifies meds by standing orders
• If questions, quick clinician consultIf questions, quick clinician consult
• Health coach f/u by phone or e-mailHealth coach f/u by phone or e-mail
• Clinician barely involvedClinician barely involved
• Blood pressure control improved with this innovationBlood pressure control improved with this innovation
[Margolius et al, Annals of Family Medicine 2012;10:199][Margolius et al, Annals of Family Medicine 2012;10:199]
23. Share the care:Share the care:
MA acts as scribe while MD does physical examMA acts as scribe while MD does physical exam
24. EMR pushes more work to physician, leading toEMR pushes more work to physician, leading to
vast amounts of time spent documentingvast amounts of time spent documenting
If changes are notIf changes are not
made to reduce thesemade to reduce these
time penalties ontime penalties on
primary careprimary care
physicians there will bephysicians there will be
no primary careno primary care
physicians left tophysicians left to
penalize.penalize. Clement J McDonaldClement J McDonald
MD, Arch Intern Med 2012;172:285-287MD, Arch Intern Med 2012;172:285-287
(Clem McDonald created one of the(Clem McDonald created one of the
first EMRs in the 1970s)first EMRs in the 1970s)
25. Vast amounts of time spent documentingVast amounts of time spent documenting
• Scribing
• Assistant order
entry
• Re-engineering
the prescription
renewal work out
of the practice
• I come in to my doctor for anI come in to my doctor for an
examination, but it seems allexamination, but it seems all
he wants to do is examinehe wants to do is examine
the computer.the computer. Patient 3/2/12Patient 3/2/12
• I used to be a doctor. Now II used to be a doctor. Now I
am a typist.am a typist. Internist Anchorage ALInternist Anchorage AL
• I really like my doctor of overI really like my doctor of over
10 years, but rarely get to10 years, but rarely get to
talk with her face to face; astalk with her face to face; as
I’m talking, she is typing.I’m talking, she is typing.
Annoys the hell out of me.Annoys the hell out of me.
Patient, 12/30/10Patient, 12/30/10
27. Scribes to reduce documentation timeScribes to reduce documentation time
• University of Utah “Care by Design”
• Right person/right job
• MAs receive additional training
• MA takes history using EMR templates
• MD reviews history does physical exam and MA
enters findings into EMR
• MD calls out lab, imaging, prescriptions and MA
enters them as pended orders that MD quickly Oks
• Profits up, patient satisfaction up, provider
satisfaction up, quality measures up
Blash et al, UCSF Center for the Health Professions, April 2011
28. The best way to reduce burnoutThe best way to reduce burnout
29. Closing the demand-capacity gap: share the careClosing the demand-capacity gap: share the care
• CliniciansClinicians
• Non-clinician team membersNon-clinician team members
– Non-professionalNon-professional
• MAs as panel managersMAs as panel managers
• MAs as health coachesMAs as health coaches
• MAs as scribesMAs as scribes
– ProfessionalProfessional
• RNsRNs
• PharmacistsPharmacists
• Physical therapistsPhysical therapists
• BehavioristsBehaviorists
• PatientsPatients
– Peer health coachesPeer health coaches
– Self careSelf care
• TechnologyTechnology
30. Team-based care: stable teamletsTeam-based care: stable teamlets
PatientPatient
panelpanel
Clinician/MAClinician/MA
teamletteamlet
PatientPatient
panelpanel
Clinician/MAClinician/MA
teamletteamlet
PatientPatient
panelpanel
Clinician/MAClinician/MA
teamletteamlet
Health coach, behavioral health professional,Health coach, behavioral health professional,
social worker, RN, pharmacist, panel manager,social worker, RN, pharmacist, panel manager,
complex care managercomplex care manager
31. Share the care with professional teamShare the care with professional team
members using standing ordersmembers using standing orders
• RNs treat uncomplicated UTIs, URIs, STIs, and low back pain withoutRNs treat uncomplicated UTIs, URIs, STIs, and low back pain without
clinicians: equal quality and better patient satisfactionclinicians: equal quality and better patient satisfaction
• Physical therapists manage low back pain with better functional reliefPhysical therapists manage low back pain with better functional relief
and patient satisfaction compared with physiciansand patient satisfaction compared with physicians
• RNs or pharmacists can care for a sub-panel of patients with diabetes,RNs or pharmacists can care for a sub-panel of patients with diabetes,
hypertension, hyperlipidemia with minimal clinician involvementhypertension, hyperlipidemia with minimal clinician involvement
• Behaviorists in primary care improve depression outcomesBehaviorists in primary care improve depression outcomes
• RN complex care managers can provide much of the care for time-RN complex care managers can provide much of the care for time-
consuming, complex, high-utilizing patientsconsuming, complex, high-utilizing patients
• These changes can add 10-20% capacity without more clinician timeThese changes can add 10-20% capacity without more clinician time
Saint et al, Am J Med 1999;106;636; Overman et al, Phys Ther 1988;68:199;Saint et al, Am J Med 1999;106;636; Overman et al, Phys Ther 1988;68:199; http:http:
//impact-uw//impact-uw.org.org; Bodenheimer and Berry-Millett, RWJF Synthesis Project, DecemberBodenheimer and Berry-Millett, RWJF Synthesis Project, December
20092009;; Bodenheimer and Smith, Health Affairs 2013;32:1881-6Bodenheimer and Smith, Health Affairs 2013;32:1881-6
32. Share the care with patients:Share the care with patients:
peer health coachespeer health coaches
• Patients trained as peer health coaches can add capacityPatients trained as peer health coaches can add capacity
• VA diabetic patients paired with peers had greater glycemicVA diabetic patients paired with peers had greater glycemic
improvement than patients with nurse care managersimprovement than patients with nurse care managers
[Heisler et al, Ann Intern Med 2010;153:507][Heisler et al, Ann Intern Med 2010;153:507]
• Latino diabetic patients with peer-led classes: betterLatino diabetic patients with peer-led classes: better
glycemic control than usual careglycemic control than usual care [Philis-Tsimikas et al, Diab Care[Philis-Tsimikas et al, Diab Care
2011;34:1926]2011;34:1926]
• Diabetes patients with a peer coach had greater HbA1cDiabetes patients with a peer coach had greater HbA1c
reductions than usual care patientsreductions than usual care patients [Long et al, Ann Intern Med[Long et al, Ann Intern Med
2012;156:416]2012;156:416]
• Low-income diabetic patients with low-income peerLow-income diabetic patients with low-income peer
coaches achieved better glycemic control than usual carecoaches achieved better glycemic control than usual care
patientspatients [Thom et al, Ann Fam Med 2013;11:137-144][Thom et al, Ann Fam Med 2013;11:137-144]
34. 0
5
10
15
20
25
30
35
40
45
50
2000 2005 2010 2015 2020
Percent change relative to 2001
Adult primary care: capacity vs. demandAdult primary care: capacity vs. demand
Demand for careDemand for care
==
Capacity toCapacity to
provide careprovide care
Thinking differentlyThinking differently
Sharing the careSharing the care adds capacityadds capacity
Patient self-carePatient self-care reduces demandreduces demand
Share the careShare the care
Self careSelf care
35. Reducing demand through self careReducing demand through self care
• Home pregnancy kits, home HIV testingHome pregnancy kits, home HIV testing
• Internet sites (good and not good)Internet sites (good and not good)
• More OTC medicationsMore OTC medications
• Patients with home blood pressure monitors whoPatients with home blood pressure monitors who
self-titrate their medications can achieve betterself-titrate their medications can achieve better
blood pressure control than that achieved by MDsblood pressure control than that achieved by MDs
• Patients on anti-coagulation who home-monitor andPatients on anti-coagulation who home-monitor and
self-titrate warfarin doses can achieve better INRself-titrate warfarin doses can achieve better INR
control than MDs.control than MDs.
McManus et al, Lancet 2010;376:163; Heneghan et al, LancetMcManus et al, Lancet 2010;376:163; Heneghan et al, Lancet
2012;379:322.2012;379:322.
36. Add capacity, reduce demand through technologyAdd capacity, reduce demand through technology
• Much panel management can be done by computersMuch panel management can be done by computers
rather than MAs. Computers identify care gaps, remindrather than MAs. Computers identify care gaps, remind
patients. MAs needed only when patients don’t respond.patients. MAs needed only when patients don’t respond.
• Computers can be programmed to authorize med refillsComputers can be programmed to authorize med refills
without expenditure of human effortwithout expenditure of human effort (Healthfinch.com)(Healthfinch.com)
• Patient self-care for uncomplicated UTI is safe andPatient self-care for uncomplicated UTI is safe and
effective. Patients enter UTI symptoms into aeffective. Patients enter UTI symptoms into a
kiosk/vending machine.kiosk/vending machine. If no red flags, 3 days ofIf no red flags, 3 days of
antibiotics are dispensed from vending machine. Noantibiotics are dispensed from vending machine. No
involvement of health care personnel.involvement of health care personnel.
• Cell phone otoscopes allow parents to dx peds earCell phone otoscopes allow parents to dx peds ear
infections or send to clinician via patient portalinfections or send to clinician via patient portal
37. Take-home pointsTake-home points
• The “primary care physician shortage” must beThe “primary care physician shortage” must be
re-conceptualized as a demand-capacity gapre-conceptualized as a demand-capacity gap
• Capacity can be increased by sharing largeCapacity can be increased by sharing large
amounts of care with non-cliniciansamounts of care with non-clinicians
• Patients not only receive, but can provide carePatients not only receive, but can provide care
as peer coachesas peer coaches
• Demand can be reduced through growth of selfDemand can be reduced through growth of self
carecare
• Technology can facilitate this transformationTechnology can facilitate this transformation
• In the future, primary care will be dramaticallyIn the future, primary care will be dramatically
differentdifferent
38. The Building Blocks ofThe Building Blocks of
High-PerformingHigh-Performing
Primary CarePrimary Care
Think differentlyThink differently
Editor's Notes
Our building blocks to high performing primary care were developed as a roadmap to guide practices during transformation. Transforming to a primary care medical home requires more than checking boxes and capturing screen shots.
I will spend the rest of the presentation discussing how the blocks were developed, the overall sequencing, practical implementation of the components of each block and showcase exemplars from high-performing sites and from other clinics that we are familiar with or coach.
Our building blocks to high performing primary care were developed as a roadmap to guide practices during transformation. Transforming to a primary care medical home requires more than checking boxes and capturing screen shots.
I will spend the rest of the presentation discussing how the blocks were developed, the overall sequencing, practical implementation of the components of each block and showcase exemplars from high-performing sites and from other clinics that we are familiar with or coach.